Takotsubo Cardiomyopathy After Esophageal Surgery in a Patient With Undiagnosed Coronary Artery Disease

Takotsubo cardiomyopathy (TCM), also known as "broken heart syndrome" or stress cardiomyopathy, is a transient, non-ischemic form of heart failure characterized by left ventricular apical ballooning, elevated cardiac enzymes, and regional systolic dysfunction. It commonly presents with symptoms similar to acute coronary syndrome (ACS), leading to frequent misdiagnosis. TCM is often triggered by significant emotional or physical stress, with a notable predilection in postmenopausal women. Although typically reversible, the condition's pathophysiology remains incompletely understood, with the most accepted theory linking it to excessive catecholamine release and myocardial dysfunction. We present a case of a 73-year-old female who developed TCM following an elective right thoracotomy for esophageal cyst resection. The patient exhibited elevated cardiac enzymes and arrhythmias postoperatively. Despite an initial suspicion of ACS, further cardiac work-up, including echocardiography and cardiac catheterization, showed new-onset severe systolic dysfunction and apical ballooning characteristic of TCM. Interestingly, the patient also had an undiagnosed coronary artery disease incidentally found during cardiac catheterization. The patient's condition improved over the following months, with normalization of left ventricular function, supporting the reversible nature of TCM. This case underscores the need for thorough evaluation when diagnosing heart failure with no clear ischemic cause, ensuring that ACS or CAD is not overlooked. While TCM can be resolved with appropriate care, careful clinical judgment is essential to avoid misdiagnosis and optimize patient outcomes.